Thoughts On U.S. Health Care

My Monday comments on Michael Moore’s new film, SiCKO, and the $2 million tab that my mother’s horseback riding accident cost our family last fall elicited excellent material from readers.

Robert J. Manna in Rome, Georgia:

I’m a chiropractor and I know the health care system in the U.S. needs help. In fact, it’s not “health care” at all….it’s sickness and crisis care. There’s little emphasis on research into true health care and wellness.

Well over of 75% of the problems that plague Americans today are preventable. However, little is done to teach people the lifestyle changes that will promote wellness. There’s big money in crisis care, and chronic disease, but we need to make the system less about money, and more about what’s best for people. We need to end the medical monopoly that clearly isn’t working.

A recent study showed that people who chose D.C.s (chiropractors) as opposed to M.D.s (medical doctors) as their primary care providers had 85% lower medication costs, had 60% fewer hospital admissions, and 62% fewer outpatient surgeries and procedures.

A major answer to decreasing medical costs in the United States is looking towards the diet and lifestyle of cultures that know best…the Okinawans, for one. They live long, prosperous, healthy lives with little need for drugs or major medical interventions.

I agree that an ounce of prevention is worth a pound of cure. In my mother’s case, however, it was a traumatic event that put her in the hospital and no amount of prevention would have worked, aside from refraining from horseback riding. No matter what, though, accidents happen.

That’s not meant to downplay Bob’s point. A doctor friend of mine once told me that in his thirty years of practice he’d come to realize the two tenets of basic health:

  • Don’t smoke
  • Excercise three times a week

That’s it. He said none of the elixirs, vitamins, supplements, herbs, or other products do any better than those two bits of advice. Oh, and drink lots of water.

Longtime Kelly Letter subscriber Hans Burkholder is a surgery resident, and he sent this:

The general trend is for hospitals to get more, and physicians to get less. As a surgery resident, I follow the surgical literature. Reimbursements for many surgical procedures are now half of what they were in the late 1980s, and that is in real dollars, not adjusted for inflation. In the late 1980s, Medicare paid a surgeon about $4,000 for doing a CABG (Coronary Artery Bypass Graft), now it pays about $2,000. The same is true for many other surgical procedures as well. Even though the pay for surgeons has been cut, things such as office costs and malpractice costs have skyrocketed.

Malpractice costs vary enormously from state to state. For surgeons, Florida is the most expensive with annual malpractice costs of $300,000 per year. Minnesota, on the other hand, has a malpractice rate of $10,000 per year for surgeons.

All of this has led to several trends in surgery. Surgeons are retiring at a younger age than they used to. If you were working back in the 1980s and now you’re doing the same procedures but for less money, retirement looks appealing. The other trend is that surgeons are demanding money from hospitals for being on call for their ERs. Doctors cannot unionize to stop pay cuts from medicare/insurance. However, hospitals have a strong well-funded lobby, and have been able to secure pay increases from medicare. Since an increasing proportion of ER patients seen by surgeons are self-pay (i.e. no-pay — or a liability since they may sue you) they are trying to obtain reimbursement for being on call.

The medical system in this country is broken. Everyone expects to get a Cadillac but only wants to pay for a Buick. All the doctors are afraid of the lawyers, and therefore order reams of unnecessary tests.

I’m not sure that socialized health care is the answer. I lived in Canada until I was in my early 20s. The health care system there has problems and is not the panacea that folks like Michael Moore would have us believe.

If I were installed as dictator for life, I would make several changes to the American health care system:

  • I would modify the legal system in the following ways:
    • Cap pain and suffering pay-outs
    • Make the suing lawyer and client responsible for the defendant’s legal costs and missed working time if the lawsuit is deemed to have been frivolous
    • Limit who is allowed to testify as an expert witness to true experts in the field
  • I would limit the insurance companies’ ability to deny claims or disenroll patients.
  • I would institute a single central claims assessing agency to which all hospitals and physicians would submit claims. This claim would then be evaluated and approved or denied. If approved, the insurance company would have a strict timetable to make payment. As things now stand, they send you endless forms or denials. This way they keep the money in the bank longer and therefore have a higher working capital.
  • Every citizen would have a magnetized card with their entire medical history on it in a centralized database. Every hospital would use the same software and would log every patient visit into the database. There a large number of drug seeking patients in the system. They go from hospital to hospital complaining of things like back pain. An expensive battery of labs and radiographic studies are performed — mostly to keep the lawyers at bay. The patient is then sent home with the narcotic they were looking for to begin with. With a centralized system, you could look in the computer and see that those tests had all been done a week ago at the hospital down the street. You would then save the system the costs of repeating all those tests.

This is quite a proposal. I imagine many would balk at the idea of their medical history being encoded on a magnetic card to prevent druggies from pulling a fast one, but there seem to be other benefits, such as avoiding the runaround from primary physician to specialized care people in the event of an emergency. Slip the card into the medical file reader and — voila! — everything the ER team needs pops up on screen where it could be viewed or printed for the rounds binder.

Paul Nixon in Houston, Texas:

I don’t exactly consider Michael Moore an expert on health care but rather a film producer whose only goal is to make money. I congratulate him for his ability to make money but do not for an instant believe any of the messages he tries to deliver in any of his entertaining films. Singers should sing, actors should act, politicians should politic, environmental experts should be environmental experts, investors should invest and each needs to understand that their stage is not the other.

That stated, I pray for your personal situation with medical challenges. Medical insurance is important to have and hopefully your family will find assistance in dealing with such a large bill.

I should point out that my family is fine on the financial front — one benefit of having a son and brother in the money business. Other families, however, don’t enjoy that benefit and that’s the point Michael Moore is spotlighting in SiCKO. He may not be an expert on the medical system in the sense that he’s not a doctor or president of an HMO, but he’s a heck of a researcher and his facts seem to be correct. That makes him expert enough for the purpose of his film.

Note, however, that CNN and Mr. Moore disagree on some of the facts used in SiCKO, according to this article
, link provided by Brian Donnelly.

According to yesterday’s posting on Michael Moore’s site, on the other hand, is this:

CNN confirmed that all of our statistics in “Sicko” are the correct numbers from the sources we cited. Although CNN still prefers to use older World Health Organization statistics, we will stick to using this year’s Bush administration stats and more recent U.N. data.

Paul wrote that the real goal of Mr. Moore’s films is to make money. True, he’s a for-profit entity, but there are lots of ways to turn a profit and he chose one that makes a compelling case for health care reform. I sell books for a living and I expect to make a profit doing so, but I also believe what I write and hope that the books do more than just pay me. I assume that Mr. Moore has a similar stance with his films. He expects them to turn a profit, but he also believes in their messages and hopes to see them make a difference.

John Gontarz:

I feel there are aspects of the U.S. medical system that need changing. For one thing we do need a system where the rates insurers pay for medical procedures and medications is available to all. I bet the $2 million you refer to regarding your mother is an uninsured cost. I suspect the insured costs would be closer to $200K or $300K. This is still a lot but a lot less and more manageable to many. I recently had surgery where the doctor’s bill was over $5,000 but where the price paid by the insurance company was about $500.

On the other hand, I lived in England and used the U.K. medical system, have had a number of experiences while traveling in other foreign countries, and have friends who have been assigned to jobs in Canada. In all these experiences the level and speed of medical service available in the U.S. is far superior to that available abroad.

I was in Norway last week with my wife and we both had bad head colds. I tried to buy simple cold medications like Coricidin HBP, Sudafed, Dextromethorphan (Robitussin DM) and we were told at the apothecary that we needed a doctor’s prescription for each of these U.S. over-the- counter medications. Likewise when I lived in the U.K. and got the flu, it took three visits to my assigned doctor along with a threat to do physical harm to the doctor on my last visit before I got medication which worked to suppress my cough and allow me to sleep and win my battle with the virus.

My friend Jim moved to Toronto, Canada with his wife and two children. The care there for his ill son was so poor and his condition was deteriorating so rapidly that he drove his family to Buffalo to get proper care for his child. His child’s health was so poor that he was admitted and in intensive care for two days before he was released from the hospital. Jim feels that if he had stayed in Canada that his son would have died. From that point on, Jim drove to Buffalo for medical care.

I suspect in other countries the following saying fits well: “A person who doesn’t know, doesn’t know what he doesn’t know.” My experiences say socialized medicine stinks and I want no part of it.

In his film, Moore mentions that Cuban medical care compares favorably to U.S. medical care. I bet if there is a non-biased body out there that it would say the level of care in the U.S. is much higher than in Cuba.

The only non-U.S. health care I’ve experienced is Japan’s, and it’s been a mixed bag. Japan believes that U.S. drugs are too powerful for the “Japanese physique,” so the doses are weak to the point of being ineffective.

I once broke out in hives in Japan, as I’ve done at various times in the U.S. as well, and I knew exactly the medication I needed. I told the doctor, and he supposedly gave it to me. In the U.S., the hives disappeared within an hour of receiving the shot. In Japan, after 30 minutes on an IV, I still had them and three hours later I thought I would die from the itchiness and returned to the doctor to complain.

Ultimately, I needed to have a doctor friend of mine sneak into the hospital pharmacy to get a bottle of the medicine I needed in pill form. She came to my home in the middle of the night with the illicitly-gotten medication, and warned me to take the pills “very slowly, just one or two at a time.” I promised I would, then proceeded to imbibe half the bottle after she left. Two hours later, I slept soundly, hive free, and wondered what I would have done without the inside connection.

So, I agree with John that nowhere is perfect, but that doesn’t mean we shouldn’t try to fix the egregiously broken parts of the U.S. system.

For all the complaining that has gone on in my family and all the grousing about U.S. health care that SiCKO has created, one fact stands out in my mind:

The fine doctors at St. Anthony Central Hospital in Denver saved my mother’s life.

Tomorrow: At last I’ll get to Starbucks, the iPhone, and Power Investor software.

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